PAMELA POWELL
Lynwood,Illinois
Summary
Dynamic HEDIS Review Nurse with extensive experience at BCforward, excelling in data abstraction and quality assurance. Proven track record in ensuring regulatory compliance while enhancing medical record review processes. Skilled in EPIC charting and adept at collaborating with teams to achieve optimal patient outcomes. Committed to maintaining high standards in healthcare quality.
Overview
24
24
years of professional experience
1
1
Certification
Work History
HEDIS Review Nurse
BCforward
10.2024 - 05.2025
- Accurately over-read medical records and abstractions performed by HEDIS abstractor weekly.
- Reviewed sample abstractions from assigned abstractors, translating specifications to data collection tools.
- Reported findings to manager while ensuring HIPAA compliance.
- Completed IRR/Over-read tool, identifying errors in comment sections.
- Abstracted and reviewed medical records for each HEDIS measure.
- Measures abstracted: CBP, IMA, CDC, COL, CCS, CIS, AWC, TRC, COA, PPC
HEDIS Review Nurse
BCforward
Indianapolis, IN
08.2023 - 05.2024
- Accurately over-read medical records and abstractions performed by HEDIS abstractor weekly.
- Reviewed sample abstractions from assigned abstractors, translating specifications to data collection tools.
- Reported findings to manager while ensuring HIPAA compliance.
- Completed IRR/Over-read tool, identifying errors in comment sections.
- Abstracted and reviewed medical records for each HEDIS measure.
- Measures abstracted: CBP, IMA, CDC, COL, CCS, CIS, AWC, TRC, COA, PPC
HEDIS Nurse
BCforward
11.2022 - 05.2023
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
BCforward
10.2021 - 05.2022
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
BCforward
01.2021 - 05.2021
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
BCforward
11.2020 - 05.2021
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
BCforward
01.2020 - 03.2020
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
BCforward
01.2019 - 05.2019
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Review Nurse
All Medical Personnel
Atlanta, Georgia
12.2017 - 05.2018
- Assisted with the development, implementation, and maintenance of audit processes related to HEDIS measures.
- Attended meetings and webinars related to Health Plan Quality Improvement initiatives.
HEDIS Nurse
BCforward
01.2018 - 05.2018
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Maintained up-to-date knowledge of all applicable regulations, guidelines, and accreditation requirements pertaining to HEDIS measures.
- Collected, recorded and analyzed data related to nursing care of patients.
HEDIS Nurse
All Medical Staffing
Atlanta, GA
01.2017 - 05.2017
- Accurately over-read medical records and abstractions performed by HEDIS abstractor weekly.
- Reviewed sample abstractions from assigned abstractors, translating specifications to data collection tools.
- Reported findings to manager while ensuring HIPAA compliance.
- Completed IRR/Over-read tool, identifying errors in comment sections.
- Abstracted and reviewed medical records for each HEDIS measure.
- Measures abstracted: CBP, IMA, CDC, COL, CCS, CIS, AWC, TRC, COA, PPC, W34, W15.
HEDIS Nurse
CIGNA Health Spring
Chicago, IL
10.2014 - 01.2016
- Review and abstract pertinent medical records information in accordance with multiple study criteria
- Obtain information from medical records copied from physician offices/healthcare facilities
- Collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical records pursuits
- Data entry into ORION-HEDIS data base and assisting with validation
- HEDIS Hybrid Measures; Controlling High Blood Pressure, Comprehensive Diabetes Care, Care of Older Adult, Adult BMI Assessment, Colorectal Cancer Screening, Medication Reconciliation Post Discharge
- Faxed, scanned and emailed medical records request
- Maintain schedules and project deadlines for department manager and director, including technical assistance on operational issues such as record keeping and training.
- Acting as liaison between insurance company, providers and other departments to provide accurate support.
- Interaction and onsite training with the medical staff, (nurses, medical records technician) at the providers office to ensure the correct information was being sent to the HEDIS abstractors
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Performed quality assurance reviews on all chart abstractions before submitting final analysis report.
- Conducted outbound calls to providers in order to obtain additional information needed for accurate reporting of HEDIS measure results.
Clinical Research Nurse/Coordinator
Morehouse School of Medicine
Atlanta, GA
10.2010 - 04.2014
- Collect vital signs, bodily specimens (blood and urine), 12 lead EKG’s and other biometric data for research protocols.
- Administer study medications and monitor participant reactions throughout protocol
- Make daily rounds in research center to ensure safety and infection control
- Maintain up-to-date records of all employee health information
- Maintain study drug and emergency medication inventory; submit supply orders when needed
- Assist on several study protocols: Multiple Myeloma, COPD, Nicotine, and Cardiovascular studies
- Maintain the accuracy of all research data by adhering to Good Clinical Practice
- CQI charts and maintain research center compliance with NIH and JCAHO
- Generate graphs and charts of monthly research center activities
- Recruit patients from various Atlanta metro communities and health fairs
- Maintained accurate records of protocol-related documents such as informed consent forms and source documents.
Interim Nurse Supervisor/Lead LPN/Advice Nurse
Morehouse School of Medicine
Atlanta, GA
12.2007 - 11.2010
- Front and back office Interim Supervisor for a staff of 5 employees
- Maintained the clinical flow of patients and delegated assignments to clinical staff
- Managed the Pediatric Advice Nurse telephone line according to protocol.
- Made daily rounds to ensure compliance with OSHA standards and clinic policies and procedures.
- Assisted physicians with in-office procedures, administering medications, and vaccinations
- Maintained all record keeping, including laboratory procedures, referrals, and medication inventory for private and VCF (state ordered medications)
- Ensured that clinical policies and procedures were being followed.
- Participated in monthly pediatric meetings with the faculty physicians
- Assisted with yearly job specific training for staff (BP, strep testing, glucose testing, GYN set-up, etc.)
- Utilized EPIC electronic medical records system to abstract data based on inclusion and exclusion criteria
- Abstracting EMR (electronic medical records) for billing reconciliation
- Utilize ICD-9-CM, CPT, CDM, HCPCS knowledge
- Utilizing various systems to gather information and completed referral request
- Contacted primary care physicians and specialist for clinical information to support request for services requiring pre-certification.
- Assisted pediatric/Internal Medicine clinic staff in HEDIS (on site) 2008-2010 reviews
Home Care/Private Duty Nurse
Maxim Healthcare
Atlanta, GA
09.2001 - 09.2007
- Private duty nurse for adult and pediatric ventilator-dependent and quadriplegic patients
- Performed tracheostomy care, urinary catheter insertion, I.C. and bowel program
- Assisted with activities of daily living.
Education
Practical Nursing Diploma -
Atlanta Area Technical School
Atlanta, GA01.1993
Skills
- HEDIS measurement
- Data abstraction
- Quality assurance
- Medical record review
- Regulatory compliance
- EPIC charting
Certification
- Medical Skills: phlebotomy, PPD testing, injections, tracheostomy care, nebulizer treatments, blood and specimen collection, IV insertions.
- Interpersonal Skills: Alzheimer’s/Dementia, substance abuse, pediatric experience
- Emory Healthcare Nursing Research Residency- Completed 5/2011
- American Heart Association CPR/AED/BLS Healthcare Provider Certified
- American Heart Association Stroke Certification
- Specimen Packing, Shipping, and Handling Certification
- CITI (Collaborative Institutional Training Initiative) Certification
- Human Subjects Ethics Training
- Compliance Auditing, Electronic Medical Records, HEDIS, Quality Control auditing
Timeline
HEDIS Review Nurse
BCforward
10.2024 - 05.2025
HEDIS Review Nurse
BCforward
08.2023 - 05.2024
HEDIS Nurse
BCforward
11.2022 - 05.2023
HEDIS Nurse
BCforward
10.2021 - 05.2022
HEDIS Nurse
BCforward
01.2021 - 05.2021
HEDIS Nurse
BCforward
11.2020 - 05.2021
HEDIS Nurse
BCforward
01.2020 - 03.2020
HEDIS Nurse
BCforward
01.2019 - 05.2019
HEDIS Nurse
BCforward
01.2018 - 05.2018
HEDIS Review Nurse
All Medical Personnel
12.2017 - 05.2018
HEDIS Nurse
All Medical Staffing
01.2017 - 05.2017
HEDIS Nurse
CIGNA Health Spring
10.2014 - 01.2016
Clinical Research Nurse/Coordinator
Morehouse School of Medicine
10.2010 - 04.2014
Interim Nurse Supervisor/Lead LPN/Advice Nurse
Morehouse School of Medicine
12.2007 - 11.2010
Home Care/Private Duty Nurse
Maxim Healthcare
09.2001 - 09.2007
Practical Nursing Diploma -
Atlanta Area Technical School
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